ADULT Updated: February 2, 2021

Regimen Reference Order – GYNE – + CARBOplatin ARIA: GYNE – [DOCEtaxel + CARBOplatin] Planned Course: Every 21 days until disease progression or unacceptable toxicity Indication for Use: Primary or Recurrent Ovarian or Endometrial ; Recurrent Cervix Cancer CVAD: At Provider’s Discretion Proceed wiith treatment iiff:: Cyclle 1 ANC equal to or greater than 1.5 x 109/L AND equal to or greater than 100 x 109/L Cyclle 2 and onwards ANC equal to or greater than 1.2 x 109/L AND Platelets equal to or greater than 75 x 109/L ❖ Contact Physician if parameters not met

SEQUENCE OF MEDICATION ADMINISTRATION Pre-treatment Requirements Drug Dose CCMB Administration Guideline

dexamethasone 8 mg Orally twice a day the day before DOCEtaxel treatment and one dose the morning of DOCEtaxel treatment (Self-administered at home)

Treatment Regimen – GYNE – DOCEtaxel + CARBOplatin Drug Dose CCMB Administration Guideline Establish primary solution 500 mL of: normal saline

aprepitant 125 mg Orally 1 hour pre-

ondansetron 16 mg Orally 30 minutes pre-chemotherapy

dexamethasone 4 mg Orally 30 minutes pre-chemotherapy *Nursing Alert: this dose is in addition to the 8 mg self- administered dose taken at home morning of Day 1 DOCEtaxel 75 mg/m2 IV in normal saline 250 mL over 1 hour Use non-DEHP bags and non-DEHP administration sets Concentration dependent drug: Pharmacy will adjust diluent volume to ensure drug stability normal saline 100 mL ONLY for patients with a PORT IV over 12 minutes *Nursing Alert: This volume is to be administered after standard flush

Please refer to CCMB Formulary for Criteria for Use Page 1 of 3

ADULT GYNE – DOCEtaxel + CARBOplatin

CARBOplatin AUC 6 mg/mL.min; IV in normal saline 250 mL over 1 hour maximum dose 900 mg (see table below)

In the event of an infusion-related hypersensitivity reaction, refer to the ‘Hypersensitivity Reaction Standing Order’ REQUIRED MONITORING All Cycles • CBC, serum creatinine and liver enzymes as per Physician Orders • Full vital signs (temperature, heart rate, respiratory rate, blood pressure and O2 saturation) at baseline and as clinically indicated • No observation period is required after DOCEtaxel administration. Patient can be discharged from treatment room if stable whether they had a reaction or not

Recommended Support Medications Drug Dose CCMB Administration Guideline aprepitant 80 mg Orally once daily on Days 2 and 3

dexamethasone 8 mg Orally once daily on Days 2 and 3

metoclopramide 10 – 20 mg Orally every 4 hours as needed for and

DISCHARGE INSTRUCTIONS

• Patients should be instructed to contact their cancer team immediately if symptoms of hypersensitivity reactions occur after discharge • Instruct patient to continue taking anti-emetic(s) at home • Reinforce applicable safe handling precautions of medications, blood and body fluids for 48 hours after completion of chemotherapy

ADDITIONAL INFORMATION

• CARBOplatin dose considerations: o CCMB Gynecological DSG uses actual body weight to calculate GFR o CCMB Gynecological DSG uses a maximum CARBOplatin dose of 900 mg o As renal function can fluctuate over time, changes to creatinine clearance between cycles may not result in CARBOplatin dose changes from the prescriber o CARBOplatin dose should be recalculated every 3 cycles at minimum o If calculated CARBOplatin dose differs more than 10% from prescribed CARBOplatin dose, contact the prescriber

Please refer to CCMB Formulary for Criteria for Use Page 2 of 3

ADULT GYNE – DOCEtaxel + CARBOplatin

CARBOplatin Dosing Calculations per CCMB Gynecological DSG

Calculation of CARBOplatin dose: (max. 900 mg )

Dose (mg) = target AUC (GFR + 25)

GFR = N x (140-age in years) x Actual Body Weight (kg) = ___ mL/min

serum creatinine in umol/L N = 1.04 in females

AUC GFR + 25 Total Dose

(mg/mL.min) X (mL/min) = (mg)

6 ____ + 25

AUC= Area Under Curve

The estimated creatinine clearance is based on limited evidence. Sound clinical judgment and interpretation of the estimation are required, because the equation may not be appropriate for some patient populations (for example, acute renal failure).

Please refer to CCMB Formulary for Criteria for Use Page 3 of 3